Pub Date : 2024-09-21DOI: 10.1177/15266028241280685
Thomas Zeller, Zhiyuan Zhang, Helen Parise, Carolyn Mascho, Andrew Holden, Andrej Schmidt, Marcus Thieme, Michael Piorkowski, Klaus Hertting, Christian Wissgott, Martin Andrassy, Elias Noory, Ido Weinberg, Raghu Kolluri
Purpose: Vessel recoil is a common phenomenon occurring in the tibial vessels following balloon angioplasty. This study examined the occurrence and short-term impact of acute vessel recoil in a subset of patients treated with retrievable scaffold therapy (RST) via the Spur Peripheral Retrievable Scaffold System (Spur).
Methods: Patients with tibial disease underwent angiography immediately following RST, and then 15 minutes post-treatment. Vessel recoil was defined as a ≥10% decrease in lumen diameter after 15 minutes. Recoil was further analyzed by late lumen loss method, subsegmental late lumen loss method, and smallest segment to same segment method. Patient and vessel characteristics were evaluated. Functional recoil (acute vessel spasm), defined as no significant change in minimal lumen diameter (MLD) at baseline compared with 15 minutes post-treatment, was also evaluated.
Results: Of the 38 patients (40 lesions; 33 men [87%]; mean [SD] age 75.3 [8.2] years; 26 (68.4%) with diabetes mellitus); recoil was noted in 42.5% of vessels. Prior to treatment, 13 lesions (32.5%) were total occlusions, the mean lesion length was 64.7±30.4 mm, and 27.5% (11/40) were moderate or severely calcified. Mean treated lesion length was 97.8±39.6 mm. For lesions evaluable by duplex ultrasound, 86.7% of vessels (26/30) were patent at 6 months. There was no significant difference in patency between lesions with recoil and lesions without recoil (81.8% vs 89.5%); there was a trend toward patency in the non-recoil group. Two lesions had functional recoil (acute vessel spasm) and were patent at 6 months. There was no statistically significant correlation of recoil to comorbidities or lesion characteristics, including calcification, for which there was also no correlation to patency.
Conclusion: Vessel recoil was noted in 42.5% of vessels treated with RST, whereas previous published rates with balloon angioplasty demonstrated vessel recoil up to 97%, suggesting that RST may impact vessel recoil. This exploratory study did not demonstrate a correlation between vessel recoil and patency at 6 months.
Clinical impact: Retrievable scaffold therapy may replace scoring devices and cutting devices for vessel preparation before definite (drug) therapy. Retrievable scaffold therapy supplements already established vessel preparation strategies in order to follow the concept of leaving nothing behaind. A temporary retrievable scaffold for changing vessel compliance and potentially releasing antiproliferative drugs represents a new interventional concept.
{"title":"Early Tibial Vessel Recoil Following Treatment With the Bare Temporary Spur Stent System: Results From the DEEPER OUS Vessel Recoil Substudy.","authors":"Thomas Zeller, Zhiyuan Zhang, Helen Parise, Carolyn Mascho, Andrew Holden, Andrej Schmidt, Marcus Thieme, Michael Piorkowski, Klaus Hertting, Christian Wissgott, Martin Andrassy, Elias Noory, Ido Weinberg, Raghu Kolluri","doi":"10.1177/15266028241280685","DOIUrl":"https://doi.org/10.1177/15266028241280685","url":null,"abstract":"<p><strong>Purpose: </strong>Vessel recoil is a common phenomenon occurring in the tibial vessels following balloon angioplasty. This study examined the occurrence and short-term impact of acute vessel recoil in a subset of patients treated with retrievable scaffold therapy (RST) via the Spur Peripheral Retrievable Scaffold System (Spur).</p><p><strong>Methods: </strong>Patients with tibial disease underwent angiography immediately following RST, and then 15 minutes post-treatment. Vessel recoil was defined as a ≥10% decrease in lumen diameter after 15 minutes. Recoil was further analyzed by late lumen loss method, subsegmental late lumen loss method, and smallest segment to same segment method. Patient and vessel characteristics were evaluated. Functional recoil (acute vessel spasm), defined as no significant change in minimal lumen diameter (MLD) at baseline compared with 15 minutes post-treatment, was also evaluated.</p><p><strong>Results: </strong>Of the 38 patients (40 lesions; 33 men [87%]; mean [SD] age 75.3 [8.2] years; 26 (68.4%) with diabetes mellitus); recoil was noted in 42.5% of vessels. Prior to treatment, 13 lesions (32.5%) were total occlusions, the mean lesion length was 64.7±30.4 mm, and 27.5% (11/40) were moderate or severely calcified. Mean treated lesion length was 97.8±39.6 mm. For lesions evaluable by duplex ultrasound, 86.7% of vessels (26/30) were patent at 6 months. There was no significant difference in patency between lesions with recoil and lesions without recoil (81.8% vs 89.5%); there was a trend toward patency in the non-recoil group. Two lesions had functional recoil (acute vessel spasm) and were patent at 6 months. There was no statistically significant correlation of recoil to comorbidities or lesion characteristics, including calcification, for which there was also no correlation to patency.</p><p><strong>Conclusion: </strong>Vessel recoil was noted in 42.5% of vessels treated with RST, whereas previous published rates with balloon angioplasty demonstrated vessel recoil up to 97%, suggesting that RST may impact vessel recoil. This exploratory study did not demonstrate a correlation between vessel recoil and patency at 6 months.</p><p><strong>Clinical impact: </strong>Retrievable scaffold therapy may replace scoring devices and cutting devices for vessel preparation before definite (drug) therapy. Retrievable scaffold therapy supplements already established vessel preparation strategies in order to follow the concept of leaving nothing behaind. A temporary retrievable scaffold for changing vessel compliance and potentially releasing antiproliferative drugs represents a new interventional concept.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1177/15266028241278137
Max Hoebink, Liliane C. Roosendaal, Marie-José Beverloo, Arno M. Wiersema, T. van der Ploeg, Thomas A. H. Steunenberg, Kak Khee Yeung, Vincent Jongkind
Purpose:Previous studies have shown that activated clotting time (ACT)–guided heparinization leads to better anticoagulation levels during noncardiac arterial procedures (NCAP) than a standardized bolus of 5000 IU. Better anticoagulation should potentially result in lower incidence of thrombo-embolic complications (TEC). Comparative investigations on clinical outcomes of these heparinization strategies are scarce. This study investigated clinical outcomes of ACT-guided heparinization with a starting dose of 100 IU/kg in comparison with a single standardized bolus of 5000 IU heparin during NCAP.Materials and methods:Analysis from a prospectively collected database of patients undergoing NCAP in 2 vascular centers was performed. Patients receiving ACT-guided heparinization were matched 1:1 with patients receiving 5000 IU heparin using propensity score matching (PSM). Primary outcomes were TEC, bleeding complications, and mortality within 30 days of procedure or during the same admission.Results:A total of 759 patients (5000 IU heparin: 213 patients, ACT-guided heparinization: 546 patients) were included. Propensity score matching resulted in 209 patients in each treatment group. After PSM, the groups were comparable, with the exception of a higher prevalence of peripheral arterial disease in the ACT-guided heparinization group (103 patients, 49% vs 82 patients, 39%, p=0.039). The target ACT (>200 seconds) was reached in 198 patients (95%) of the ACT-guided group versus 71 patients (34%) of the 5000 IU group (p<0.001), indicating successful execution of the ACT-guided protocol. Incidence of TEC (13 patients, 6.2% vs 10 patients, 4.8%, p=0.52), mortality (3 patients, 1.4% vs 0 patients, p=0.25), and bleeding complications (32 patients, 15% vs 25 patients, 12%, p=0.32) did not differ between patients receiving ACT-guided heparinization and 5000 IU heparin. Protamine was administered in 118 patients (57%) in the ACT group versus 11 patients (5.3%) in the 5000 IU group (p<0.001), but did not influence incidence of TEC (17 patients, 5.9% vs 6 patients, 4.7%, p=0.61) or bleeding complications (34 patients, 12% vs 22 patients, 17%, p=0.14).Conclusion:No difference in TEC, bleeding complications, or mortality was found between ACT-guided heparinization and a single bolus of 5000 IU heparin during NCAP.Clinical ImpactPrevious studies have shown that activated clotting time (ACT)-guided heparinization leads to better anticoagulation levels during non-cardiac arterial procedures (NCAP) then a standardized bolus of 5000 IU. Comparative investigations on clinical outcomes are scarce. This study focussed on clinical outcomes of both protocols in NCAP in a propensity score matched cohort. Thrombo-embolic complications (TEC), bleeding complications and mortality within 30 days after NCAP or during the same admission were comparable between groups. Future studies should focus on optimizing ACT-guided protocols, specifically in patients with a high risk of T
目的：先前的研究表明，在非心脏动脉手术（NCAP）中，以活化凝血时间（ACT）为指导的肝素化能带来比 5000 IU 标准栓剂更好的抗凝水平。更好的抗凝效果可能会降低血栓栓塞并发症（TEC）的发生率。有关这些肝素化策略临床效果的比较研究很少。本研究调查了ACT引导下肝素化的临床效果，与NCAP期间单次标准化栓注5000 IU肝素相比，起始剂量为100 IU/kg。采用倾向评分匹配法（PSM）将接受ACT引导肝素化治疗的患者与接受5000 IU肝素治疗的患者进行1:1匹配。结果：共纳入 759 例患者（5000 IU 肝素：213 例，ACT 引导肝素化：546 例）。倾向评分匹配后，每个治疗组均有 209 名患者。在 PSM 后，两组患者具有可比性，但 ACT 引导肝素化治疗组的外周动脉疾病患病率更高（103 名患者，49% 对 82 名患者，39%，P=0.039）。ACT 指导组中有 198 名患者（95%）达到了目标 ACT（>200 秒），而 5000 IU 组中有 71 名患者（34%）（p<0.001），这表明 ACT 指导方案执行成功。接受 ACT 引导肝素化疗和 5000 IU 肝素化疗的患者在 TEC 发生率（13 例患者，6.2% vs 10 例患者，4.8%，P=0.52）、死亡率（3 例患者，1.4% vs 0 例患者，P=0.25）和出血并发症（32 例患者，15% vs 25 例患者，12%，P=0.32）方面没有差异。ACT组118名患者（57%）与5000 IU组11名患者（5.3%）使用了原胺（p<0.001），但并不影响TEC（17名患者，5.9% vs 6名患者，4.7%，p=0.61）或出血并发症（34名患者，12% vs 22名患者，17%，p=0.14）的发生率。临床影响以往的研究表明，在非心脏动脉手术（NCAP）中，以活化凝血时间（ACT）为指导的肝素化与单一的 5000 IU 肝素栓剂相比，能获得更好的抗凝水平。有关临床结果的比较研究很少。本研究以倾向评分匹配队列为对象，重点研究了两种方案在非心脏动脉手术中的临床疗效。血栓栓塞并发症 (TEC)、出血并发症和 NCAP 后 30 天内或同一入院期间的死亡率在两组之间具有可比性。未来的研究应侧重于优化 ACT 指导方案，特别是针对 TEC 和出血并发症风险较高的患者。
{"title":"Clinical Outcomes of 5000 IU Heparin Versus Activated Clotting Time–Guided Heparinization During Noncardiac Arterial Procedures: A Propensity Score Matched Analysis","authors":"Max Hoebink, Liliane C. Roosendaal, Marie-José Beverloo, Arno M. Wiersema, T. van der Ploeg, Thomas A. H. Steunenberg, Kak Khee Yeung, Vincent Jongkind","doi":"10.1177/15266028241278137","DOIUrl":"https://doi.org/10.1177/15266028241278137","url":null,"abstract":"Purpose:Previous studies have shown that activated clotting time (ACT)–guided heparinization leads to better anticoagulation levels during noncardiac arterial procedures (NCAP) than a standardized bolus of 5000 IU. Better anticoagulation should potentially result in lower incidence of thrombo-embolic complications (TEC). Comparative investigations on clinical outcomes of these heparinization strategies are scarce. This study investigated clinical outcomes of ACT-guided heparinization with a starting dose of 100 IU/kg in comparison with a single standardized bolus of 5000 IU heparin during NCAP.Materials and methods:Analysis from a prospectively collected database of patients undergoing NCAP in 2 vascular centers was performed. Patients receiving ACT-guided heparinization were matched 1:1 with patients receiving 5000 IU heparin using propensity score matching (PSM). Primary outcomes were TEC, bleeding complications, and mortality within 30 days of procedure or during the same admission.Results:A total of 759 patients (5000 IU heparin: 213 patients, ACT-guided heparinization: 546 patients) were included. Propensity score matching resulted in 209 patients in each treatment group. After PSM, the groups were comparable, with the exception of a higher prevalence of peripheral arterial disease in the ACT-guided heparinization group (103 patients, 49% vs 82 patients, 39%, p=0.039). The target ACT (>200 seconds) was reached in 198 patients (95%) of the ACT-guided group versus 71 patients (34%) of the 5000 IU group (p<0.001), indicating successful execution of the ACT-guided protocol. Incidence of TEC (13 patients, 6.2% vs 10 patients, 4.8%, p=0.52), mortality (3 patients, 1.4% vs 0 patients, p=0.25), and bleeding complications (32 patients, 15% vs 25 patients, 12%, p=0.32) did not differ between patients receiving ACT-guided heparinization and 5000 IU heparin. Protamine was administered in 118 patients (57%) in the ACT group versus 11 patients (5.3%) in the 5000 IU group (p<0.001), but did not influence incidence of TEC (17 patients, 5.9% vs 6 patients, 4.7%, p=0.61) or bleeding complications (34 patients, 12% vs 22 patients, 17%, p=0.14).Conclusion:No difference in TEC, bleeding complications, or mortality was found between ACT-guided heparinization and a single bolus of 5000 IU heparin during NCAP.Clinical ImpactPrevious studies have shown that activated clotting time (ACT)-guided heparinization leads to better anticoagulation levels during non-cardiac arterial procedures (NCAP) then a standardized bolus of 5000 IU. Comparative investigations on clinical outcomes are scarce. This study focussed on clinical outcomes of both protocols in NCAP in a propensity score matched cohort. Thrombo-embolic complications (TEC), bleeding complications and mortality within 30 days after NCAP or during the same admission were comparable between groups. Future studies should focus on optimizing ACT-guided protocols, specifically in patients with a high risk of T","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives:Our study aimed to investigate the correlations between radiomics-based assessment and outcomes, including positive aortic remodeling (PAR), reintervention for dissection at 1 year, and overall survival, in patients with Type B aortic dissection (TBAD) who underwent thoracic endovascular aortic repair (TEVAR).Methods:This was a single-center, retrospective, cohort study. The cohort comprised 104 patients who had undergone TEVAR of TBAD in our institution between January 2010 and October 2022. We segmented preoperative computed tomography (CT) images of the patients’ descending aorta regions, then extracted a comprehensive set of radiomic features, including first-order features, shape features (2D and 3D), gray-level co-occurrence matrix (GLCM), gray-level size zone matrix, gray-level run length matrix, gray-level dependence matrix, neighborhood gray-tone difference matrix, from the regions of interest. Next, we selected radiomics features associated with total descending aorta positive aortic remodeling (TDA-PAR) and reintervention by least absolute shrinkage and selection operator (LASSO) regression and features associated with survival by LASSO-Cox regression. This enabled us to calculate radiomics-based risk scores for each patient. We then allocated the patients to high and low radiomics-based risk groups, the cutoff being the median score. We used 3 different models to validate the radiomics-based risk scores.Results:The patients’ baseline characteristics did not differ between those who achieved TDA-PAR and those who did not. The radiomics-based risk scores were significantly and independently associated with all 3 outcomes. As to the impact of specific radiomics features, we found that GLSZM_SmallAreaLowGrayLevelEmphasis and shape_Maximum2DDiameterColumn had positive impacts on both reintervention and survival outcomes, whereas GLCM_Idmn positively affected survival but negatively affected reintervention. We found that radiomics-based risk for TDA-PAR correlated most significantly with zone 6 PAR.Conclusions:Radiomics-based risk scores were significantly associated with the outcomes of TDA-PAR, reintervention, and overall survival. Radiomics has the potential to make significant contributions to prediction of outcomes in patients with TBAD undergoing TEVAR.Clinical ImpactIn this study of 104 patients with Type B aortic dissection, we demonstrated associations between radiomics-based risk and postoperative outcomes, including total descending aorta positive aortic remodeling, reintervention and survival. These findings highlight radiomics’ potential as a tool for risk stratification and prognostication in acute Type B aortic dissection management.
目的：我们的研究旨在调查接受胸腔内血管主动脉修复术（TEVAR）的B型主动脉夹层（TBAD）患者基于放射组学的评估与结果之间的相关性，包括主动脉重塑（PAR）阳性、1年后因夹层再次介入以及总生存期。该队列包括2010年1月至2022年10月期间在我院接受TEVAR治疗的104例TBAD患者。我们对患者降主动脉区域的术前计算机断层扫描（CT）图像进行了分割，然后从感兴趣区域提取了一整套放射组学特征，包括一阶特征、形状特征（二维和三维）、灰度级共现矩阵（GLCM）、灰度级大小区矩阵、灰度级运行长度矩阵、灰度级依赖性矩阵、邻域灰调差异矩阵。接下来，我们通过最小绝对收缩和选择算子（LASSO）回归法选出了与全降主动脉正性重塑（TDA-PAR）和再介入相关的放射组学特征，并通过 LASSO-Cox 回归法选出了与生存相关的特征。这样，我们就能为每位患者计算出基于放射组学的风险评分。然后，我们将患者分配到基于放射组学的高风险组和低风险组，分数中位数为分界线。结果：达到 TDA-PAR 和未达到 TDA-PAR 的患者的基线特征没有差异。基于放射组学的风险评分与所有 3 种结果都有显著的独立相关性。至于特定放射组学特征的影响，我们发现 GLSZM_SmallAreaLowGrayLevelEmphasis 和 shape_Maximum2DDiameterColumn 对再干预和生存结果都有积极影响，而 GLCM_Idmn 对生存有积极影响，但对再干预有消极影响。我们发现，基于放射组学的 TDA-PAR 风险与 6 区 PAR 的相关性最为显著。临床影响在这项针对 104 名 B 型主动脉夹层患者的研究中，我们证实了基于放射组学的风险与术后结果（包括总降主动脉正性主动脉重塑、再介入和存活率）之间的关联。这些发现凸显了放射组学作为急性 B 型主动脉夹层管理中风险分层和预后判断工具的潜力。
{"title":"Radiomics-Based Risk Assessment Correlates With Outcomes in Patients With Acute Type B Aortic Dissection Undergoing Thoracic Endovascular Repair","authors":"Zhiye Wu, Jun Lin, Pingfan Guo, Fanggang Cai, Jinchi Zhang, Wanglong Li, Yihang Cai, Xuemei Wu, Qiaoyi Wu, Yiquan Dai, Xinhuang Hou","doi":"10.1177/15266028241275828","DOIUrl":"https://doi.org/10.1177/15266028241275828","url":null,"abstract":"Objectives:Our study aimed to investigate the correlations between radiomics-based assessment and outcomes, including positive aortic remodeling (PAR), reintervention for dissection at 1 year, and overall survival, in patients with Type B aortic dissection (TBAD) who underwent thoracic endovascular aortic repair (TEVAR).Methods:This was a single-center, retrospective, cohort study. The cohort comprised 104 patients who had undergone TEVAR of TBAD in our institution between January 2010 and October 2022. We segmented preoperative computed tomography (CT) images of the patients’ descending aorta regions, then extracted a comprehensive set of radiomic features, including first-order features, shape features (2D and 3D), gray-level co-occurrence matrix (GLCM), gray-level size zone matrix, gray-level run length matrix, gray-level dependence matrix, neighborhood gray-tone difference matrix, from the regions of interest. Next, we selected radiomics features associated with total descending aorta positive aortic remodeling (TDA-PAR) and reintervention by least absolute shrinkage and selection operator (LASSO) regression and features associated with survival by LASSO-Cox regression. This enabled us to calculate radiomics-based risk scores for each patient. We then allocated the patients to high and low radiomics-based risk groups, the cutoff being the median score. We used 3 different models to validate the radiomics-based risk scores.Results:The patients’ baseline characteristics did not differ between those who achieved TDA-PAR and those who did not. The radiomics-based risk scores were significantly and independently associated with all 3 outcomes. As to the impact of specific radiomics features, we found that GLSZM_SmallAreaLowGrayLevelEmphasis and shape_Maximum2DDiameterColumn had positive impacts on both reintervention and survival outcomes, whereas GLCM_Idmn positively affected survival but negatively affected reintervention. We found that radiomics-based risk for TDA-PAR correlated most significantly with zone 6 PAR.Conclusions:Radiomics-based risk scores were significantly associated with the outcomes of TDA-PAR, reintervention, and overall survival. Radiomics has the potential to make significant contributions to prediction of outcomes in patients with TBAD undergoing TEVAR.Clinical ImpactIn this study of 104 patients with Type B aortic dissection, we demonstrated associations between radiomics-based risk and postoperative outcomes, including total descending aorta positive aortic remodeling, reintervention and survival. These findings highlight radiomics’ potential as a tool for risk stratification and prognostication in acute Type B aortic dissection management.","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1177/15266028241280503
Emad M. Al-Osail, Thomas Le Houérou, Antoine Gaudin, Alessandro Costanzo, Dominique Fabre, Stephan Haulon
Iatrogenic type A aortic dissection following thoracic endovascular aortic repair (TEVAR) is a life-threatening complication, with reported incidence rates ranging from 1.3% to 6.8%. Urgent open surgical repair is recommended when this complication occurs. In the present case, surgery was not performed at the onset of symptoms in a 61-year-old female initially treated with TEVAR for an acute type B aortic dissection. She was referred to our center 3 months later with a chronic type A dissection with the primary entry tear located in the arch. In this very fragile patient, we performed an endovascular repair with an arch branched endograft in combination with surgical debranching of the right carotid and left subclavian arteries.Clinical ImpactBranched endograft exclusion of chronic type A dissections resulting from a TEVAR complication is a minimally-invasive approach to consider in very fragile patients to mitigate the potential risks associated with conventional open surgical repair.
胸腔内血管主动脉修复术（TEVAR）后先天性 A 型主动脉夹层是一种危及生命的并发症，据报道其发生率为 1.3% 到 6.8%。出现这种并发症时，建议立即进行开放手术修复。在本病例中，一名 61 岁的女性因急性 B 型主动脉夹层而接受 TEVAR 手术治疗，但在症状出现时并未进行手术。3 个月后，她因慢性 A 型主动脉夹层转诊至本中心，其主要入口撕裂位于主动脉弓。对于这名非常脆弱的患者，我们在进行右颈动脉和左锁骨下动脉去分支手术的同时，使用拱形分支内膜移植进行了血管内修复。临床影响对于因 TEVAR 并发症导致的慢性 A 型夹层，分支内膜移植是一种微创方法，可用于非常脆弱的患者，以降低传统开放手术修复的潜在风险。
{"title":"Endovascular Management of a Chronic Type A Aortic Dissection: Case Report","authors":"Emad M. Al-Osail, Thomas Le Houérou, Antoine Gaudin, Alessandro Costanzo, Dominique Fabre, Stephan Haulon","doi":"10.1177/15266028241280503","DOIUrl":"https://doi.org/10.1177/15266028241280503","url":null,"abstract":"Iatrogenic type A aortic dissection following thoracic endovascular aortic repair (TEVAR) is a life-threatening complication, with reported incidence rates ranging from 1.3% to 6.8%. Urgent open surgical repair is recommended when this complication occurs. In the present case, surgery was not performed at the onset of symptoms in a 61-year-old female initially treated with TEVAR for an acute type B aortic dissection. She was referred to our center 3 months later with a chronic type A dissection with the primary entry tear located in the arch. In this very fragile patient, we performed an endovascular repair with an arch branched endograft in combination with surgical debranching of the right carotid and left subclavian arteries.Clinical ImpactBranched endograft exclusion of chronic type A dissections resulting from a TEVAR complication is a minimally-invasive approach to consider in very fragile patients to mitigate the potential risks associated with conventional open surgical repair.","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1177/15266028241275804
Marco Panagrosso, Eduardo Cavallo, Umberto Marcello Bracale, Antonio Peluso, Olga Silvestri, Francesco Intrieri, Vincenzo Molinari, Antonio Esposito, Santi Trimarchi, Alberto Maria Settembrini, Chiara Lomazzi, Gaetano La Barbera, Luciano Carbonari, Andrea Angelini, Irene Morelli, Eleonora Centonza, Raffaella Berchiolli, Nicola Troisi, Valentina Scarati, Valerio Artini, Salvatore De Vivo, Pietro Volpe, Mafalda Massara, Eugenio Martelli
Purpose:The Manta Vascular Closure Device is a novel collagen-based vascular closure device that has been designed specifically for closure of large-bore percutaneous arterial accesses. The aim of this retrospective study is to evaluate the immediate and 30-day outcome of Manta at the completion of endovascular aneurysm repair (EVAR) or thoracic endovascular aortic repair (TEVAR). The hypothesis is that Manta is not inferior in obtaining hemostasis compared with the Perclose ProGlide Suture-Mediated Closure System device.Materials and Methods:We recruited all the percutaneous accesses for (T)EVAR performed from January 2021 to April 2023 by all the Italian Divisions of Vascular Surgery using Manta at the time of data collection (May 2023). The primary outcome is to evaluate the incidence of complications at the puncture site after Manta implantation and at 1 month, and compare this with ProGlide. We applied the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria for observational studies.Results:Overall, 524 consecutive femoral accesses for (T)EVAR procedures were collected: 355 in the Manta cohort and 169 in the ProGlide cohort, respectively. The size of the sheath was 17.2±2.7 Fr for Manta, 15.7±2.3 Fr for ProGlide (p<0.001). No statistically significant differences between the groups regarding age, sex, body mass index, ultrasound-guided access, femoral calcifications, intraoperative, and 30-day complications. Successful arterial closure at groin puncture sites for (T)EVAR using Manta is 90.5% and 93.1% using ProGlide. Freedom for any reintervention for any complication is 95.5% for Manta and 96% for ProGlide.Conclusion:The 2 vascular closure devices have proved to be similar in terms of complications, without any statistically significant difference, although the median size of the sheaths for (T)EVAR was statistically significantly larger when Manta has been used, compared with ProGlide.Clinical ImpactManta® is effective in the hemostasis of the access sites following the completion of (T)EVAR in this multicenter, retrospective, case-control study on 524 percutaneous femoral accesses. Compared to the more popular Proglide®, the average size of the introducers in the Manta® group was significantly larger than in the Proglide® group.
{"title":"Collagen-Based Vascular Closure Device Multicenter Italian Experience in Endovascular Aortic Aneurysm Repair Compared With Suture-Mediated Closure Vascular Device","authors":"Marco Panagrosso, Eduardo Cavallo, Umberto Marcello Bracale, Antonio Peluso, Olga Silvestri, Francesco Intrieri, Vincenzo Molinari, Antonio Esposito, Santi Trimarchi, Alberto Maria Settembrini, Chiara Lomazzi, Gaetano La Barbera, Luciano Carbonari, Andrea Angelini, Irene Morelli, Eleonora Centonza, Raffaella Berchiolli, Nicola Troisi, Valentina Scarati, Valerio Artini, Salvatore De Vivo, Pietro Volpe, Mafalda Massara, Eugenio Martelli","doi":"10.1177/15266028241275804","DOIUrl":"https://doi.org/10.1177/15266028241275804","url":null,"abstract":"Purpose:The Manta Vascular Closure Device is a novel collagen-based vascular closure device that has been designed specifically for closure of large-bore percutaneous arterial accesses. The aim of this retrospective study is to evaluate the immediate and 30-day outcome of Manta at the completion of endovascular aneurysm repair (EVAR) or thoracic endovascular aortic repair (TEVAR). The hypothesis is that Manta is not inferior in obtaining hemostasis compared with the Perclose ProGlide Suture-Mediated Closure System device.Materials and Methods:We recruited all the percutaneous accesses for (T)EVAR performed from January 2021 to April 2023 by all the Italian Divisions of Vascular Surgery using Manta at the time of data collection (May 2023). The primary outcome is to evaluate the incidence of complications at the puncture site after Manta implantation and at 1 month, and compare this with ProGlide. We applied the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria for observational studies.Results:Overall, 524 consecutive femoral accesses for (T)EVAR procedures were collected: 355 in the Manta cohort and 169 in the ProGlide cohort, respectively. The size of the sheath was 17.2±2.7 Fr for Manta, 15.7±2.3 Fr for ProGlide (p<0.001). No statistically significant differences between the groups regarding age, sex, body mass index, ultrasound-guided access, femoral calcifications, intraoperative, and 30-day complications. Successful arterial closure at groin puncture sites for (T)EVAR using Manta is 90.5% and 93.1% using ProGlide. Freedom for any reintervention for any complication is 95.5% for Manta and 96% for ProGlide.Conclusion:The 2 vascular closure devices have proved to be similar in terms of complications, without any statistically significant difference, although the median size of the sheaths for (T)EVAR was statistically significantly larger when Manta has been used, compared with ProGlide.Clinical ImpactManta® is effective in the hemostasis of the access sites following the completion of (T)EVAR in this multicenter, retrospective, case-control study on 524 percutaneous femoral accesses. Compared to the more popular Proglide®, the average size of the introducers in the Manta® group was significantly larger than in the Proglide® group.","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1177/15266028241280508
Daniel Tébar-Márquez, Alfonso Jurado-Román, Santiago Jiménez-Valero, Guillermo Galeote, Andoni García-Muñoz, Alicia Lorenzo-Hernández, Carmen Fernández-Capitán, Rosario Torres Santos-Olmo, Sergio Alcolea-Batres, Clara Ugueto, Silvio Vera-Vera, Raúl Moreno
High-risk pulmonary embolism (PE) is a serious and potentially fatal condition in pregnant and postpartum women. Clinical practice guidelines recommend managing high-risk PE in the general population with systemic thrombolysis as the first therapeutic option. However, pregnant and especially early postpartum women may have a high risk of bleeding that contraindicates this therapy. In this regard, dedicated percutaneous large-bore aspiration catheters may be a promising alternative for this population. We present 2 cases of pregnant women diagnosed with high-risk PE and an absolute contraindication to systemic thrombolysis, successfully treated with percutaneous mechanical thrombectomy using a dedicated large-bore aspiration catheter. There were no complications, and both patients were discharged with full recovery and subsequently had uncomplicated deliveries.Clinical ImpactThrough these clinical cases, we present a new protocol of action, updated with the latest evidence on percutaneous pulmonary thrombectomy using dedicated catheters, for high-risk PE in pregnant women or during the early postpartum period.
高危肺栓塞（PE）是孕妇和产后妇女的一种严重且可能致命的疾病。临床实践指南建议将全身溶栓作为治疗高危肺栓塞的首选方案。然而，孕妇尤其是早期产后妇女可能会有出血的高风险，因此禁用这种疗法。在这方面，专用的经皮大口径抽吸导管可能是这一人群的一个有前途的选择。我们介绍了两例被诊断为高风险 PE 和全身溶栓绝对禁忌症的孕妇，她们使用专用的大口径抽吸导管成功地进行了经皮机械血栓切除术。临床影响通过这些临床病例，我们介绍了一种新的行动方案，该方案根据使用专用导管经皮肺血栓切除术治疗孕妇或产后早期高危 PE 的最新证据进行了更新。
{"title":"Percutaneous Thrombectomy With Flowtriever System in Pregnant Women With High-Risk Pulmonary Embolism and Contraindications to Systemic Thrombolysis","authors":"Daniel Tébar-Márquez, Alfonso Jurado-Román, Santiago Jiménez-Valero, Guillermo Galeote, Andoni García-Muñoz, Alicia Lorenzo-Hernández, Carmen Fernández-Capitán, Rosario Torres Santos-Olmo, Sergio Alcolea-Batres, Clara Ugueto, Silvio Vera-Vera, Raúl Moreno","doi":"10.1177/15266028241280508","DOIUrl":"https://doi.org/10.1177/15266028241280508","url":null,"abstract":"High-risk pulmonary embolism (PE) is a serious and potentially fatal condition in pregnant and postpartum women. Clinical practice guidelines recommend managing high-risk PE in the general population with systemic thrombolysis as the first therapeutic option. However, pregnant and especially early postpartum women may have a high risk of bleeding that contraindicates this therapy. In this regard, dedicated percutaneous large-bore aspiration catheters may be a promising alternative for this population. We present 2 cases of pregnant women diagnosed with high-risk PE and an absolute contraindication to systemic thrombolysis, successfully treated with percutaneous mechanical thrombectomy using a dedicated large-bore aspiration catheter. There were no complications, and both patients were discharged with full recovery and subsequently had uncomplicated deliveries.Clinical ImpactThrough these clinical cases, we present a new protocol of action, updated with the latest evidence on percutaneous pulmonary thrombectomy using dedicated catheters, for high-risk PE in pregnant women or during the early postpartum period.","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1177/15266028241275827
Giulia Bertagna, Nicola Troisi, Sandro Lepidi, Lorenzo Patrone, Kak Khee Yeung, Raffaella Berchiolli, Mario D'Oria
Purpose: The aim of this project is to explore practice patterns of experienced vascular specialists involved in the treatment of patients with arterial femoro-popliteal in-stent occlusion (ISO) and to understand key concepts and shared thoughts, throughout an international cross-sectional survey.
Materials and methods: The web-based survey was in English and included 31 questions. One-hundred experts were invited by email to fill in the survey anonymously on Google Forms using a dedicated link. Reminders were sent after the first 2 weeks. In addition to reporting of pooled responses, subanalyses of answers were also performed, according to country of origin (European vs non-European), years of experience (≤20 years vs >20 years), and type of institution (Academic/University vs Non-academic/Private).
Results: A total of 77 physicians from 22 countries completed the survey. Most responders were males (70/77, 91%). Most of the participants were vascular surgeons (58/77, 75%). Endovascular therapy was the preferred option in patients presenting with either acute limb ischemia, disabling intermittent claudication, or chronic limb-threatening ischemia. Atherectomy/thrombectomy+Drug-Coated Balloon (DCB) was the preferred endovascular modality (32/77, 42%). No differences between country of origin, years of experience, and type of institution of the participants were found.
Conclusions: The international SUrvey oN TReatment Of Occluded Femoro-Popliteal Stent (SUNROOF) survey has suggested that endovascular therapy is the preferred method for the treatment of femoro-popliteal ISO. This survey could represent a good starting point for future research on comparison between open and endovascular approach and different devices, which currently lacks good-level scientific evidence and appropriate guidelines.
Clinical impact: The international SUNROOF survey included 31 questions. It was performed by 77 vascular physicians from 22 countries. More than a half of respondents considered an endovascular approach as the preferred treatment modality in acute limb ischemia, disabling intermittent claudication, or chronic limb-threatening ischemia. Most responders agreed they would intensify the follow-up protocol and anti-thrombotic medications regimen after a first in-stent occlusion episode. This survey could represent a good starting point for future research on comparison between open and endovascular approach and different devices, which currently lacks of good level scientific evidence and appropriate guidelines.
{"title":"International Cross-Sectional S<i>u</i>rvey O<i>N</i> T<i>R</i>eatment <i>O</i>f <i>O</i>ccluded <i>F</i>emoro-Popliteal Stents (SUNROOF).","authors":"Giulia Bertagna, Nicola Troisi, Sandro Lepidi, Lorenzo Patrone, Kak Khee Yeung, Raffaella Berchiolli, Mario D'Oria","doi":"10.1177/15266028241275827","DOIUrl":"https://doi.org/10.1177/15266028241275827","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this project is to explore practice patterns of experienced vascular specialists involved in the treatment of patients with arterial femoro-popliteal in-stent occlusion (ISO) and to understand key concepts and shared thoughts, throughout an international cross-sectional survey.</p><p><strong>Materials and methods: </strong>The web-based survey was in English and included 31 questions. One-hundred experts were invited by email to fill in the survey anonymously on Google Forms using a dedicated link. Reminders were sent after the first 2 weeks. In addition to reporting of pooled responses, subanalyses of answers were also performed, according to country of origin (European vs non-European), years of experience (≤20 years vs >20 years), and type of institution (Academic/University vs Non-academic/Private).</p><p><strong>Results: </strong>A total of 77 physicians from 22 countries completed the survey. Most responders were males (70/77, 91%). Most of the participants were vascular surgeons (58/77, 75%). Endovascular therapy was the preferred option in patients presenting with either acute limb ischemia, disabling intermittent claudication, or chronic limb-threatening ischemia. Atherectomy/thrombectomy+Drug-Coated Balloon (DCB) was the preferred endovascular modality (32/77, 42%). No differences between country of origin, years of experience, and type of institution of the participants were found.</p><p><strong>Conclusions: </strong>The international SUrvey oN TReatment Of Occluded Femoro-Popliteal Stent (SUNROOF) survey has suggested that endovascular therapy is the preferred method for the treatment of femoro-popliteal ISO. This survey could represent a good starting point for future research on comparison between open and endovascular approach and different devices, which currently lacks good-level scientific evidence and appropriate guidelines.</p><p><strong>Clinical impact: </strong>The international SUNROOF survey included 31 questions. It was performed by 77 vascular physicians from 22 countries. More than a half of respondents considered an endovascular approach as the preferred treatment modality in acute limb ischemia, disabling intermittent claudication, or chronic limb-threatening ischemia. Most responders agreed they would intensify the follow-up protocol and anti-thrombotic medications regimen after a first in-stent occlusion episode. This survey could represent a good starting point for future research on comparison between open and endovascular approach and different devices, which currently lacks of good level scientific evidence and appropriate guidelines.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1177/15266028241276784
Lihong Zhang, Fan Zhang, Yuzhu Wang, Shen Zhan
{"title":"Re: \"Stent Grafts Across the Elbow Joint for Access Salvage\" by Aronhime et al.","authors":"Lihong Zhang, Fan Zhang, Yuzhu Wang, Shen Zhan","doi":"10.1177/15266028241276784","DOIUrl":"https://doi.org/10.1177/15266028241276784","url":null,"abstract":"","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1177/15266028241270862
Anna-Leonie Menges, Vincent Landré, Lorenz Meuli, Alexander Zimmermann, Benedikt Reutersberg
Background: Complex endovascular repair with fenestrated or branched stent grafts is a common approach for treating various types of aortic aneurysms. Bridging stent grafts (BSs) are crucial in connecting aortic endoprosthesis to target vessels, yet current options have demonstrated significant complications.
Objective: This retrospective single-center study evaluates the initial outcomes and durability of the iCover stent graft (iCover-SG) when used as a BS in fenestrated endovascular aneurysm repair (FEVAR).
Methods: Retrospective analysis screened procedures for complex aortic aneurysms between August 2021 and January 2024. Patients who underwent FEVAR with iCover-SG as BS were included. Primary and secondary endpoints focused on freedom from iCover-SG-related target vessel instability, technical success, and postoperative outcomes.
Results: Within the cohort of 28 patients, 94 iCover-SGs were used as BS, supplying 87 target vessels. The freedom from iCover-SG-related target vessel instability throughout the study reached 94% (82/87). Technical success rates were notably high, with primary success achieved in 94% of cases and secondary success in 99%. Over the follow-up duration, there were instances necessitating reintervention related to iCover-SG, including 4 cases of endoleak, 2 cases of T1cEL, and 2 cases of T3cEL. In-hospital mortality was 7% (n=4), with 2 cases attributed to intraoperative complications. Importantly, no deaths were directly attributed to iCover-SG-related issues.
Conclusion: The iCover-SG demonstrates promising initial outcomes as a BS in FEVAR, with high technical success rates and satisfactory rates of target vessel instability. Continued monitoring and further studies are warranted to assess long-term durability and outcomes.
Clinical impact: This study shows that the iCover stent graft achieves satisfactory technical success and target vessel stability in the short- and mid-term when used as a bridging stent graft in FEVAR procedures. Its successful integration into clinical practice broadens the range of available options, providing clinicians with more versatile tools for managing complex endovascular aortic aneurysms. This expanded selection of bridging stent grafts allows for more personalised treatment strategies, improving procedural precision and patient outcomes. The iCover stent graft's reliable performance highlights its potential as a valuable addition to current endovascular techniques, ultimately enhancing patient care in challenging cases.
{"title":"iCover as Bridging Stent Graft in Fenestrated Endovascular Aortic Aneurysm Repair.","authors":"Anna-Leonie Menges, Vincent Landré, Lorenz Meuli, Alexander Zimmermann, Benedikt Reutersberg","doi":"10.1177/15266028241270862","DOIUrl":"https://doi.org/10.1177/15266028241270862","url":null,"abstract":"<p><strong>Background: </strong>Complex endovascular repair with fenestrated or branched stent grafts is a common approach for treating various types of aortic aneurysms. Bridging stent grafts (BSs) are crucial in connecting aortic endoprosthesis to target vessels, yet current options have demonstrated significant complications.</p><p><strong>Objective: </strong>This retrospective single-center study evaluates the initial outcomes and durability of the iCover stent graft (iCover-SG) when used as a BS in fenestrated endovascular aneurysm repair (FEVAR).</p><p><strong>Methods: </strong>Retrospective analysis screened procedures for complex aortic aneurysms between August 2021 and January 2024. Patients who underwent FEVAR with iCover-SG as BS were included. Primary and secondary endpoints focused on freedom from iCover-SG-related target vessel instability, technical success, and postoperative outcomes.</p><p><strong>Results: </strong>Within the cohort of 28 patients, 94 iCover-SGs were used as BS, supplying 87 target vessels. The freedom from iCover-SG-related target vessel instability throughout the study reached 94% (82/87). Technical success rates were notably high, with primary success achieved in 94% of cases and secondary success in 99%. Over the follow-up duration, there were instances necessitating reintervention related to iCover-SG, including 4 cases of endoleak, 2 cases of T1cEL, and 2 cases of T3cEL. In-hospital mortality was 7% (n=4), with 2 cases attributed to intraoperative complications. Importantly, no deaths were directly attributed to iCover-SG-related issues.</p><p><strong>Conclusion: </strong>The iCover-SG demonstrates promising initial outcomes as a BS in FEVAR, with high technical success rates and satisfactory rates of target vessel instability. Continued monitoring and further studies are warranted to assess long-term durability and outcomes.</p><p><strong>Clinical impact: </strong>This study shows that the iCover stent graft achieves satisfactory technical success and target vessel stability in the short- and mid-term when used as a bridging stent graft in FEVAR procedures. Its successful integration into clinical practice broadens the range of available options, providing clinicians with more versatile tools for managing complex endovascular aortic aneurysms. This expanded selection of bridging stent grafts allows for more personalised treatment strategies, improving procedural precision and patient outcomes. The iCover stent graft's reliable performance highlights its potential as a valuable addition to current endovascular techniques, ultimately enhancing patient care in challenging cases.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1177/15266028241274568
Mo W Kruiswijk, Siem A Willems, Stefan Koning, Floris P Tange, Jeroen J W M Brouwers, Roderick C Peul, Jan van Schaik, Abbey Schepers, Jaap Hamming, Koen E A van der Bogt, Carla S P van Rijswijk, Alexander L Vahrmeijer, Pim van den Hoven, Joost R van der Vorst
Background: Patients with lower extremity arterial disease (LEAD) frequently require revascularization procedures. Currently used diagnostic methods are insufficient in predicting successful outcomes and focus on macrovascular rather than microvascular state. Several promising modalities to increase diagnostic accuracy are emerging, including maximal systolic acceleration (ACCmax), measured by duplex ultrasound (DUS). For the assessment of tissue perfusion, near-infrared fluorescence (NIR) imaging using indocyanine green (ICG) demonstrates promising results. This study aims to identify the usefulness of combining these two methods for macrovascular and microvascular perfusion assessment to predict successful clinical outcomes.
Methods: A retrospective study was performed collecting preinterventional and postinterventional DUS and ICG NIR fluorescence imaging measurements from LEAD patients undergoing revascularization. The correlation between the preinterventional and postinterventional perfusion parameters, described as the delta (Δ) ACCmax and ΔICG NIR fluorescence parameters, were analyzed. Improvements in perfusion parameters were compared to clinical outcomes, defined as improvement in pain-free walking distance, freedom from rest pain, or tendency toward wound and ulcer healing.
Results: A total of 38 patients (42 limbs) were included. ACCmax and ICG NIR fluorescence perfusion parameters improved significantly after revascularization (p<0.001). Patients with a poor clinical outcome had a significantly lower improvement of both parameters after revascularization (p<0.001-0.016). Lack of correlation was found between the delta of ACCmax and ICG NIR fluorescence imaging. Multiple non-congruent improvements of macrovascular parameters (ACCmax) and perfusion (ICG NIR fluorescence) were seen within patients. However, for all patients with a successful clinical outcome, at least one parameter improved.
Conclusion: Combining ACCmax and ICG NIR fluorescence imaging revealed improvement in at least one parameter within all patients with a successful clinical outcome. This study highlights the potential of assessing both the macrovascular state and tissue perfusion following lower extremity revascularization, as both appear to reflect different aspects of vascularization.
Clinical impact: Numerous techniques have been developed to assess tissue perfusion to predict clinical outcomes following revascularization in patients with peripheral artery disease. However, none are widely implemented in clinical practice. This study emphasized the importance of employing multiple modalities from different perspectives for more accurate prediction. By focusing on both the macrovascular state and tissue perfusion, clinicians can better guide themselves in their treatment strategies.
{"title":"Maximal Systolic Acceleration and Near-Infrared Fluorescence Imaging With Indocyanine Green as Predictors for Successful Lower Extremity Revascularization.","authors":"Mo W Kruiswijk, Siem A Willems, Stefan Koning, Floris P Tange, Jeroen J W M Brouwers, Roderick C Peul, Jan van Schaik, Abbey Schepers, Jaap Hamming, Koen E A van der Bogt, Carla S P van Rijswijk, Alexander L Vahrmeijer, Pim van den Hoven, Joost R van der Vorst","doi":"10.1177/15266028241274568","DOIUrl":"https://doi.org/10.1177/15266028241274568","url":null,"abstract":"<p><strong>Background: </strong>Patients with lower extremity arterial disease (LEAD) frequently require revascularization procedures. Currently used diagnostic methods are insufficient in predicting successful outcomes and focus on macrovascular rather than microvascular state. Several promising modalities to increase diagnostic accuracy are emerging, including maximal systolic acceleration (ACC<sub>max</sub>), measured by duplex ultrasound (DUS). For the assessment of tissue perfusion, near-infrared fluorescence (NIR) imaging using indocyanine green (ICG) demonstrates promising results. This study aims to identify the usefulness of combining these two methods for macrovascular and microvascular perfusion assessment to predict successful clinical outcomes.</p><p><strong>Methods: </strong>A retrospective study was performed collecting preinterventional and postinterventional DUS and ICG NIR fluorescence imaging measurements from LEAD patients undergoing revascularization. The correlation between the preinterventional and postinterventional perfusion parameters, described as the delta (Δ) ACC<sub>max</sub> and ΔICG NIR fluorescence parameters, were analyzed. Improvements in perfusion parameters were compared to clinical outcomes, defined as improvement in pain-free walking distance, freedom from rest pain, or tendency toward wound and ulcer healing.</p><p><strong>Results: </strong>A total of 38 patients (42 limbs) were included. ACC<sub>max</sub> and ICG NIR fluorescence perfusion parameters improved significantly after revascularization (p<0.001). Patients with a poor clinical outcome had a significantly lower improvement of both parameters after revascularization (p<0.001-0.016). Lack of correlation was found between the delta of ACC<sub>max</sub> and ICG NIR fluorescence imaging. Multiple non-congruent improvements of macrovascular parameters (ACC<sub>max</sub>) and perfusion (ICG NIR fluorescence) were seen within patients. However, for all patients with a successful clinical outcome, at least one parameter improved.</p><p><strong>Conclusion: </strong>Combining ACC<sub>max</sub> and ICG NIR fluorescence imaging revealed improvement in at least one parameter within all patients with a successful clinical outcome. This study highlights the potential of assessing both the macrovascular state and tissue perfusion following lower extremity revascularization, as both appear to reflect different aspects of vascularization.</p><p><strong>Clinical impact: </strong>Numerous techniques have been developed to assess tissue perfusion to predict clinical outcomes following revascularization in patients with peripheral artery disease. However, none are widely implemented in clinical practice. This study emphasized the importance of employing multiple modalities from different perspectives for more accurate prediction. By focusing on both the macrovascular state and tissue perfusion, clinicians can better guide themselves in their treatment strategies.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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